Optimization criteria for ordering myeloid neoplasm next-generation sequencing

Area of Science:

• Hematology
• Oncology
• Genetics

Background:

• Myeloid neoplasms (MNs) often require next-generation sequencing (NGS) for accurate diagnosis, risk stratification, and therapy selection, as conventional methods like karyotyping may miss crucial mutations.
• However, performing NGS without clear clinical indication can lead to unnecessary investigations, increased patient distress, and higher healthcare costs.

Purpose of the Study:

• To develop and validate criteria for approving next-generation sequencing (NGS) testing in myeloid neoplasms (MNs) to maximize actionable results.
• To identify criteria for canceling MN-NGS tests that are unlikely to yield clinically significant findings.

Main Methods:

• Established specific criteria for approving and canceling MN-NGS tests, focusing on clinical suspicion of new, relapsed, or worsening disease, and end-of-induction chemotherapy.
• Retrospectively reviewed 174 MN-NGS test orders placed between August and December 2018, categorizing them into appropriate, inappropriate, and appropriately canceled groups based on the developed criteria.

Main Results:

• Of 174 MN-NGS orders, 115 were appropriate (Group A), 29 inappropriate (Group B), and 30 appropriately canceled (Group C).
• Actionable results were obtained in 65% of Group A tests, while 0% of Group B tests yielded actionable results (p < 0.0001).

Conclusions:

• Approximately one-third (59/174) of MN-NGS test orders could be safely canceled using the established criteria.
• Implementing these criteria could lead to significant annual cost savings, estimated at $150,370 in Centers for Medicare and Medicaid Services reimbursements.